Dr. Steve Fanta, a Scottsdale doctor who took lucrative payments from Insys, a Chandler drug company, has agreed to an interim order that prevents him from practicing medicine.(Photo11: Russ Wiles/The Republic)

A Scottsdale doctor who took lucrative payments from a Chandler drug company probed for its marketing of a powerful opioid spray has agreed to a state order barring him, at least temporarily, from practicing medicine.

Dr. Steve Fanto signed a July 12 interim consent agreement with the Arizona Medical Board after a board investigation found the pain specialist had "significant deviations" from the standard of medical care.

The consent agreement prohibits Fanto "from engaging in the practice of medicine" until the medical board permits him to do so.

Fanto can ask the board to release him from the practice restriction, and the board will decide based on the "totality of information" at the time of the request. The board also can suspend Fanto's medical license if he violates terms of the practice restriction, according to the consent agreement.

The medical board cited four cases in which Fanto's prescription of pain medications was questioned. The cases included one in which a 41-year-old woman died of "poly-drug toxicity" from medications, and another in which a non-cancer patient was prescribed the highest available dosage of Subsys.

Fanto did not respond to a message for comment left with a receptionist at his medical practice.

Chandler-based Insys Therapeutics markets Subsys, a fentanyl spray that's about 50 times more powerful than heroin. The U.S. Food and Drug Administration approved the powerful medication for cancer patients with breakthrough pain not controlled by conventional pain medicines.

The FDA's approval means Insys Therapeutics cannot legally market the drug to non-cancer patients. However, doctors are free to prescribe the drug “off label” for uses other than cancer.

Insys Therapeutics is facing state and federal investigations for its marketing of the drug. The federal government has charged a half dozen former Insys executives, alleging the company paid bribes in the form of speaking fees to doctors who prescribed large amounts of Subsys to non-cancer patients.

Fanto is not the only Arizona doctor who took large fees from the Chandler company. Insys paid $257,125 to Nikesh Dilip Seth, a Scottsdale anesthesiologist, through 2016, CMS records show.

Seth has not been disciplined by the medical board, which dismissed one case against Seth in March after the complainant withdrew a grievance. Another complaint is pending, according to medical-board officials.

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Pharmaceutical and medical-device companies commonly pay doctors fees to give promotional talks about a drug or a device. Doctors also may collect meal fees, and some doctors are paid to conduct research on behalf of a company.

But the U.S. attorney in Massachusetts alleges that a half dozen former Insys executives used the lucrative fees as “bribes and kickbacks” to doctors and other practitioners who frequently prescribed Subsys.

The federal indictment lists examples of improper kickbacks paid to 10 doctors, physician assistants and advanced-practice nurses in nine states. No Arizona doctors were listed in the indictment.

The medical board's investigation of Fanto involved four cases over the past two years.

According to the consent agreement, Fanto prescribed Subsys "off-label" to a 56-year-old woman at the highest available dosage, 800 micrograms, even though manufacturer instructions suggested patients start at 100 micrograms. Fanto prescribed 120 units of the high-dosage Subsys spray even though the patient claimed to use only 30 units each month.

He also prescribed opioids, benzodiazepines and other depressants to a 69-year-old woman for sleep apnea.

The board's medical consultant concluded that Fanto failed to heed a pulmonologist who "expressed concerns" about the treatment. Furthermore, the consultant determined the patient was harmed because Fanto's treatment exacerbated her sleep apnea.

Both patients were at risk of heart attack and other harms such as opioid abuse, addiction, diversion and accidental overdose, the consent agreement said.

In January 2012, a 40-year-old woman sought treatment from Fanto for "diffuse pain." She secured an array of prescriptions, including Demerol, oxycodone, doxepin, promethazine, Soma and Zanaflax.

Two days after her final visit to Fanto in January 2013, the woman, then 41, died of an overdose. A medical examiner ruled the cause to be "poly-drug toxicity" from painkillers oxycodone and Demerol, as well as the anxiety medication doxepin.

The medical board's consultant faulted Fanto for allowing the patient to self-inject Demerol even though the patient had evidence of misusing drugs — for example, seeking early refills of opioids and abnormal urine tests, according to the consent agreement.

The medical board initiated the probe of Fanto after receiving complaints from health insurers' investigative units, the settlement of a malpractice case related to the woman's overdose death, and concerns about Fanto's volume and type of prescriptions.

Arizona Gov. Doug Ducey recently declared the state's opioid epidemic a public-health emergency. The effort includes a new requirement for all licensed doctors, pharmacists, hospitals, correctional facilities, emergency medical responders, ambulance providers and medical examiners to report within 24 hours information on suspected opioid deaths, overdoses and use of the overdose-reversal drug naloxone.

The governor's order also calls for "information sharing" among a wide range of state and local government agencies, including law enforcement, county jails and boards that license health-care providers.

The Arizona Department of Health Services issued a report that showed 790 Arizonans died from overdoses of opioid prescriptions and heroin last year.